PROJECT SUMMARY Lung cancer is the leading cause of cancer death in the U.S. The National Lung Screening Trial (NLST) documented that low-dose computed tomography (CT) lung cancer screening among individuals at high risk significantly reduced lung cancer mortality, although it was also associated with a high rate of false positives leading to over-diagnosis and increased anxiety. The American Cancer Society currently recommends CT screening for those who meet the NLST's original eligibility criteria and the U.S. Preventive Task Force will provide a scientific report on the subject in 2013. Current recommendations encourage physicians and patients to consider the benefits, risks, and limitations of CT screening to make a shared decision. As cigarette smoking is the leading risk factor for lung cancer, CT screening discussions also present a teachable moment to promote smoking cessation and relapse prevention. The ultimate goal of the proposed research is to develop messages that will facilitate physician-patient discussions of lung cancer risk, CT screening, and smoking cessation/relapse prevention. Our specific aims are as follows: Aim 1. Examine patients' understanding of and concerns about lung cancer risk, CT screening, smoking cessation/ relapse prevention and the barriers/facilitators of each. We will conduct semi-structured interviews with multiethnic (black, Latino and White) bilingual (English or Spanish-speaking) current (n=15) and former (n=15) smokers who match NLST criteria and with patients (n=10) who have already undergone CT screening. Participants will be recruited from patients at the University of California, San Francisco. Aim 2. Assess physicians' perspectives on, and barriers/facilitators of providing lung cancer risk, CT screening and smoking cessation information to patients. We will conduct semi-structured interviews with 16 primary care physicians identified from the San Francisco Bay Area Collaborative Research Network. Aim 3. Assess current methods and practices of discussing lung cancer risk and CT screening results. We will conduct direct observation of 10 patients and their pulmonologists at the point of undergoing CT screening at UCSF, followed by semi-structured interviews. We will triangulate these data points to determine optimal communication strategies for physicians and their patients. We expect our research to produce a set of specific recommendations that will help physicians to communicate with their patients about lung cancer risk and CT screening, and promote informed decision-making among patients at high risk. These recommendations will also help physicians to encourage smoking cessation and relapse prevention among their patients.